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Expand Medicaid

Published October 10, 2012 5:28 pm

Pay for behavioral health
This is an archived article that was published on sltrib.com in 2012, and information in the article may be outdated. It is provided only for personal research purposes and may not be reprinted.

A man with a history of mental illness is arrested for murdering and mutilating his grandmother in her home in the Avenues. In the aftershock of the tragedy, family members complain that the murderer had been diagnosed with schizophrenia and had recently slipped into violent behavior, but he did not receive the inpatient treatment he needed.

This is the latest in an endless line of stories recounting inadequate mental health resources in this community. But there may be a beam of light in this tunnel. It will come in the form of the Affordable Care Act, also known as Obamacare. If the law is fully implemented in 2014, it will expand Medicaid coverage to tens of thousands of Utahns who do not have health insurance now. A consequence is that low-income people in Salt Lake County will have a way to pay for mental health and substance abuse services.

As a follow-up to the grisly murder on the Avenues, The Tribune reported that mental-health providers, police and the judicial system have worked to create programs and centers to provide the care that the perpetrator of this crime obviously needed. But one gap that remains is a way to pay for care for people who are not eligible for Medicaid, the federal/state program that provides health insurance for low-income people and children. In Utah today, single adults who are childless and are not aged, disabled or blind are not eligible for Medicaid.

That will change under the ACA. Medicaid will be expanded to include people with incomes up to 133 percent of the federal poverty line. That is $14,000 income for a single person, or $30,000 for a family of four.

But there's a catch. Under the U.S. Supreme Court decision that upheld most provisions of the ACA, the court held that states may opt out of the Medicaid expansion. Gov. Gary Herbert and Republican conservatives in the Legislature are arguing that Utah should opt out because the state cannot afford it. The federal government would pay 100 percent of the cost in the first three years, but thereafter the state would become obligated for 10 percent of the expansion's cost, some $239 million over 10 years.

Salt Lake County officials estimate that about 30 percent of the 44,000 people in Salt Lake County who would become Medicaid eligible, or 13,000 people, need mental health or substance abuse care. Those will be essential services under the ACA, and pre-existing conditions will not apply.

Yes, that will be expensive, but it should cut costs in the penal and judicial systems. It is humane. It will protect the community. Utah cannot afford to pass this opportunity by.